Haemorrhoidal disease The Phlebology Clinic / Haemorrhoidal disease Introduction Description of the condition Risk factors Treatment options Frequently asked questions Pelvic venous insufficiency in women Introduction Haemorrhoidal disease, commonly identified with haemorrhoids (bleeding nodules), is one of the most common diseases of civilisation. Haemorrhoidal nodules (incorrectly referred to as anal varices) is possessed by all of us. It is a normal anatomical structure found in everyone, including even young children. The term "haemorrhoid" comes from the Greek (αἱμορροΐς), is a combination of the words blood - haema and flow - rhoos. In fact, the haemorrhagic nodules are cavernous bodies, cushion-like bodies that fill with blood and represent the terminal arteriovenous connections. In a physiological situation, the haemorrhagic nodules are located above the so-called 'cystic nodule'. dentate anal lineThey have a supportive role for the anal sphincter, which prevents uncontrolled passing of gas. They play a supporting role to the anal sphincter apparatus, which prevents uncontrolled passing of gas. The field of medicine dealing with the diagnosis and treatment of this condition is proctology. It is estimated that even 50-70% population will experience an episode of haemorrhoidal disease in their lifetime. The condition affects both men and women, most commonly after the age of 30. Haemorrhoidal disease occurs when there is dilatation, elongation and overcrowding of the haemorrhoids leading to prolapse. Untreated haemorrhoids tend to enlarge and exacerbate the condition. Despite its prevalence, haemorrhoidal disease is still sometimes a taboo subject, making it difficult for patients to seek help and appropriate treatment. Haemorrhoids or varicose veins of the anus? Haemorrhoids and varices of the anus are two different conditions affecting an anatomical region called the anal canal (The anal canal is the final section of the gastrointestinal tract, connecting the rectum to the external environment, and is responsible for the controlled excretion of faeces). Haemorrhoids (otherwise bleeding nodules) are enlarged and pathologically altered venous plexuses of the anal canal and rectum. Normally, the ileocecal nodules play an important role - they help to maintain stool and gas and are involved in holding stool. Problems arise when they become excessively dilated, stagnant and prolapsed. Commonly, a distinction is made between what are known as 'bleeding nodules' and 'ileostomies'. internal haemorrhoids and external. Internal haemorrhoids are located above crestal line anusthey are covered with mucous membrane. They are not innervated, which means they do not cause pain, but they can lead to bleeding and prolapse. On the other hand, external haemorrhoids are located below the crestal line and are covered by the skin, are more easily thrombosed and are more painful due to their stronger innervation. Crest line (Latin: linea pectinata), otherwise known as toothed line (dentate line), is an irregular, serrated line located inside the anal canal, forming the border between the upper and lower parts of the canal. It is an important anatomical point. Above the dentate line, the arterial vascularisation comes from the from the superior rectal artery (from the inferior mesenteric artery), below z inferior rectal arteries (from the internal vulvar artery). The analogy is with venous drainage. Above, the blood drains into the portal vein system and below into the inferior vena cava via the internal iliac vein system.Deadline varices of the anus is quite imprecise. Sometimes external haemorrhoids are referred to as such. In fact, varicose veins of the anus are dilated venous vessels in the anal area, unrelated to the bleeding nodules. This type of varicocele is caused by volume or pressure overload rectal venous plexuswhich can manifest as dilatation of the venous vessels in the anal area. Such phenomena most often occur during pregnancy and in Patients with advanced pelvic venous insufficiency.Most common symptoms of haemorrhoidal disease (see image above) are: bleeding from the anus (light blood on the toilet paper or in the toilet bowl) prolapse of haemorrhoids (palpable) pain and discomfort in the anal area itching and burning in the anal canal area a feeling of fullness and pressure in the anus painful lumps around the anus In the early stages of haemorrhoidal disease, symptoms are usually mild and may be limited to minor bleeding or discomfort in the anus. As the disease progresses, the discomfort worsens and treatment becomes more invasive. Haemorrhoidal disease is characterised by a gradual worsening of symptoms and enlargement of the bleeding nodules. In order to standardise treatment management and better understand the severity of the disease, clinicians use a division into four stages of haemorrhoidal disease: Stadium I Haemorrhoids are enlarged but do not prolapse outside the anal canal; they are only visible on anoscopic examination; typical symptoms are slight bleeding, itching and discomfort. Stadium II haemorrhoids fall out of the anal canal during stool pushing, but spontaneously return to their place; symptoms worsen - bleeding is more profuse and discomfort more troublesome. Stage III haemorrhoids prolapse from the anal canal during stool pushing and do not retract spontaneously; manual drainage of the nodules into the anal canal is necessary; pain becomes more severe. Stadium IV the haemorrhoids are permanently outside the anal canal; it is not possible to drain them into the anal canal; the patient experiences severe pain, burning and itching; there is a risk of complications such as thrombosis, ischaemia and necrosis of the bleeding nodules. Graphic depicting the successive stages of hemorrhoidal disease based on the 4-level classification. This system, introduced by Jean Godart (a renowned French proctologist) and adapted by other specialists, characterizes hemorrhoidal changes based on their location relative to the dentate line (linea dentata) and the severity of prolapse symptoms Factors that increase the risk occurrence of haemorrhoidal disease genetic predisposition age Pregnancy (haemorrhoids affect 85% pregnant women) obesity pelvic venous insufficiency (PVI) a low-fibre diet constipation diarrhoea weightlifting sedentary lifestyle Haemorrhoidal disease and pelvic venous insufficiency Pelvic venous insufficiency and haemorrhoidal disease show interlinkageswhich point to the important influence of disturbances in the pelvic venous circulation on the formation of bleeding nodules. Volume overload of the internal iliac veins, which is particularly common in multiparous women, plays a key role here. The branches of the internal iliac veins are connected by a network of vessels to the haemorrhoidal plexuses. Of greatest importance in the pathophysiology of this process are the following inferior rectal veins and internal labia. Reflux, or retrograde blood flow, in the internal iliac veins can lead to stasis in the vessels of the rectum and anus, resulting in dilated and prolapsed haemorrhoids. Contemporary research shows that among women with pelvic venous insufficiency, Approximately one third also had haemorrhoids. In comparison, in the group without pelvic vein reflux, this percentage was significantly lower. Furthermore, the severity of haemorrhoidal disease seemed to correlate with the extent and severity of reflux in the internal iliac veins. For example, bilateral insufficiency of these veins was associated with a higher incidence of haemorrhoids than unilateral. Recognition and diagnosis of haemorrhoidal disease Haemorrhoidal disease is a very common end-stage gastrointestinal condition. However, only a specialist doctor - proctologist surgeon - can make the correct diagnosis and qualify the patient for appropriate treatment. During proctological examination The proctologist assesses the area around the anus and rectum for the presence of bleeding nodules (haemorrhoids). Some of the lesions may already be visible to the "naked eye" or felt with a finger during a per rectum examination. Sometimes the assessment of the anal canal and rectum requires the use of a proctological speculum - an anoscope or rectoscope. These are specialised instruments with a light source that allow close inspection of the mucosa. Although haemorrhoids are the most common cause of complaints of the anal area, there are other, rarer conditions that give similar symptoms. These include: anal fissure perianal fistula anal venous plexus thrombosis anal and rectal cancer Did you know? Laser haemorrhoid removal (LHP) treatment carried out using the ELVeS 1470 system is an alternative to previously performed procedures for the treatment of haemorrhoidal disease. Maciej Chwaliński, MD On the basis of the patient's history, physical examination and additional tests (e.g. anoscopy, rectoscopy or transrectal ultrasound), the proctologist surgeon will assess the cause and extent of the lesions. On this basis, he or she will propose appropriate treatment - from minimally invasive outpatient procedures to surgery under general anaesthesia. Treatment of haemorrhoidal disease The decision on the merits of treatment of haemorrhoidal disease is undertaken depending on the stage of the disease and, above all, the severity of the symptoms experienced by the patient. In the early stages of the disease (I and II), conservative treatment is usually sufficient, while in more advanced cases (stages III and IV), surgical treatment may be necessary. Nowadays, minimally invasive methods are usually used (see below). Conservative treatment aims to alleviate the symptoms of haemorrhoidal disease, such as pain, itching, burning and bleeding from the anal canal, and to prevent further progression of the disease. Surgical treatment of haemorrhoidal disease is slowly being replaced by minimally invasive methods such as laser haemorrhoid removal (LHP). To methods conservative treatment belong:change of diet: an important part of conservative treatment is a diet rich in fibre, which regulates bowel function and prevents constipation. It is important to eat plenty of vegetables, fruit, whole-grain products and to drink adequate amounts of water. phlebotropic drugs: These drugs strengthen blood vessel walls, improve blood circulation and reduce swelling. They are used both orally and topically, in the form of ointments and suppositories. anal area hygiene: regular washing of the anal area with lukewarm water and a mild, low pH soap is important to keep the area clean and prevent irritation. Avoid using toilet paper, which can irritate the skin. warm soaks: baths in warm water with herbs, e.g. chamomile, calendula, relieve pain, itching and burning. avoiding factors that aggravate symptoms: avoid prolonged sitting or standing, heavy lifting, consumption of spices, alcohol and coffee.When conservative treatment is unsuccessful or the disease is at too advanced a stage (III or IV), it may be necessary to surgical treatment. Among the most popular methods surgical treatment belong:guming (Barron's method): involves placing a rubber band at the base of the haemorrhoid to cut off the blood supply, leading to the nodule dying and falling off. sclerotherapy: involves the injection of an obliterating substance into the haemorrhoid, which causes it to become fibrotic and smaller. photocoagulation: involves irradiating the haemorrhoids with infrared radiation, which leads to shrinking and fibrosis. DG-HAL method: involves ligation of the haemorrhoidal arteries under ultrasound guidance, which cuts off the blood supply to the haemorrhoids and causes them to shrink. laser method (LHP): the method of choice in the Department of Phlebology surgical removal of bleeding nodules - This procedure is painful and has a risk of complications. Laser treatment of haemorrhoids At Phlebology Clinic we use a state-of-the-art, minimally invasive method to treat haemorrhoids - the LHP (Laser Haemorrhoidoplasty). The procedure involves inserting the tip of a special fibre-optic cable into the dilated haemorrhoidal nodule and precisely applying a beam of laser light. The laser energy shrinks the blood vessels and haemorrhoid tissues, without having to cut them out. LHP is a modern, minimally invasive surgical technique, distinguished by: high level of patient comfort - hourly surgery without hospitalisation very high efficacy of 95% (permanent elimination of haemorrhoids) low invasiveness and safety of the procedure rapid return of the patient to normal activity (usually after 2-4 days) no significant complications - bleeding or infection are very rare good tolerance of the procedure - the patient does not feel much pain. Laser treatment of haemorrhoids - what does it involve? Wondering how to get rid of haemorrhoids? One of the most modern and effective ways is laser treatment of haemorrhoids. LHP (English. Laser HemorrhoidoPlasty) is a precise and minimally invasive technique that involves inserting a fibre optic cable into the affected bleeding nodule and directing a laser beam of light at it, allowing the problem to be quickly and effectively resolved. Mostlyquestions asked Are pregnancies and childbirth conducive to the occurrence of haemorrhoids? Yes, subsequent pregnancies are a significant risk factor for haemorrhoidal disease in women. This is due to the pressure of the enlarged uterus on the pelvic veins and hormonal changes that relax the walls of the blood vessels. Repeated episodes of venous stasis during pregnancy can, over time, lead to permanent pelvic venous insufficiency and secondarily haemorrhoids. The very mechanism of pushing during childbirth, which damages the structure of the bleeding nodules, is also important. Can haemorrhoids cause anaemia? In prolonged and advanced haemorrhoidal disease with frequent bleeding from the anal canal, iron deficiency anaemia may develop. This is due to chronic blood loss from the haemorrhoids. Typical symptoms of anaemia include pale skin, weakness, shortness of breath and palpitations. Laboratory tests show reduced levels of haemoglobin, haematocrit, iron and ferritin. In such cases, it is necessary not only to treat the haemorrhoids themselves, but also to compensate for the deficiency with iron preparations. Untreated anaemia can lead to serious health consequences. Czym zajmuje się lekarz proktolog (koloproktolog)? A proctologist is a doctor who specialises in diagnosis and treatment of diseases of the anus and rectum. He deals with, inter alia, haemorrhoidal disease, anal fissures and fistulas, rectal inflammation and stenosis, rectal prolapse, anal and rectal tumours, infections of the anal area. He performs examinations such as anoscopy, rectoscopy, rectal manometry, transrectal ultrasound, among others. What does a typical proctology examination look like? The basic proctological examination consists of viewing the anal area, examining the rectum with a finger through the anus (known as an examination of the per rectum) and on the performance of anoscopyThis is the insertion of a speculum into the anal canal. Sometimes it is also necessary to rectoscopy - lower bowel speculum. These examinations are brief and usually not very painful, although they may be experienced as uncomfortable in particularly sensitive individuals. Adequate preparation - passing stool before the visit - is important. When should you see a proctologist? A proctologist should be seen when there are worrying symptoms such as pain, itching, burning in the anal area, anal bleeding, palpable lumps in the anal area, prolapse of haemorrhoids or a feeling of constant fullness/pressure in the anus. Regular proctology visits are also recommended for people over 50 as part of the prevention of colorectal cancer. Explore our latest publications and research papers. The scientific activities of the team at the Department of Phlebology make a significant contribution to the development of modern phlebology. Our scientific research and publications confirm the effectiveness of innovative and proprietary treatment methods, setting new standards in the treatment of venous diseases. 1 / Do patients with recurrent venous disease benefit more from sequential treatment than patients without previous venous interventions? The doctors of the Phlebology Clinic have pioneered the causal treatment of venous disease worldwide. Our proprietary treatment methods, validated by scientific research and prestigious publications, have opened up new possibilities for all phlebology patients. 2 / Can the number of pregnancies be a predictor of venous disease progression and influence the effectiveness of treatment? The introduction of a proprietary haemodynamic and radiological classification used in the assessment of ovarian venous insufficiency has facilitated treatment planning for patients with pelvic venous insufficiency. This proprietary method allows for a precise assessment of blood flow abnormalities, enabling clinicians to select the optimal therapeutic strategy. 3 / Radiological-hemodynamic classification of ovarian venous insufficiency The doctors of the Phlebology Clinic were pioneers in the use of the varicose vein bonding method in Poland. We were the first to introduce this innovative, minimally invasive technique into clinical practice in our country. We encourage you to read the results of a study comparing the effectiveness of adhesive and intravenous laser ablation in the treatment of venous insufficiency of the lower limbs. 4 / A 2-year follow-up study evaluating treatment of limbic venous insufficiency using cyanoacrylate glue and intravenous laser ablation Dr Venus: virtual patient advisor Looking for an answer to your vein question? Ask our Dr. Venus! Ask Dr Venus a question Could my haemorrhoids have come out after pregnancy? Yes, haemorrhoids can occur after pregnancy. In fact, they are a fairly common problem among pregnant women and after childbirth. 01 / Vascular spider veins Dilated subcutaneous capillaries and reticular veins are a common symptom heralding the development of venous insufficiency. Their occurrence should not be underestimated. 02 / Varicose veins of the lower limbs They are the most common symptom of venous insufficiency of the lower limbs. Their occurrence should not be underestimated. At the Phlebology Clinic, we treat venous disease causally. 03 / Venous edema of the shin An enlargement of the shin circumference that increases in the evening, accompanied by a feeling of heaviness, is usually a symptom of venous insufficiency. Think about having a venous Doppler ultrasound examination! 04 / Pelvic venous insufficiency Painful and prolonged periods, heaviness in the legs during menstruation, pain during intercourse and burning in the intimate area are just some of the symptoms of pelvic venous insufficiency. Find out more! 05 / Venous compression syndromes It is a group of anatomically determined venous disorders leading to early onset of pelvic venous insufficiency and varicose veins on the legs. It affects both ladies and gentlemen! 06 / Venous disease in pregnancy Not sure when to start wearing compression stockings? Do you suspect vulvar varicose veins or have noticed sudden swelling of a limb during pregnancy! Don't wait to develop venous disease - consult our phlebologist for your symptoms. 07 / Varicose veins of the spermatic cord Up to 40% cases of male infertility may be related to varicose veins of the seminal vagina. This form of pelvic venous insufficiency is one of the more common causes of varicose veins on the legs and a cause of discomfort in the groin and scrotum. Early diagnosis increases the chance of a full cure! 08 / Venous thrombosis Swelling of the leg, pain and redness are alarm signals that should not be ignored. Venous thrombosis is an emergency condition that requires immediate diagnosis by Doppler ultrasound. If untreated, it can lead to life-threatening pulmonary embolism. 01 / 08 Modern vein treatment We offer treatment both on an outpatient basis and in day ward admissions. The stay is of short duration. The patient spends between 1 and 5 hours in the Clinic. Make an appointment
